The RN Utilization Management Specialist, under the direction of the Manager, Utilization Management serves a key role in coordinating the organization’s interdisciplinary effort to assess and effectively use organizational resources and to track and minimize the inappropriate use of such resources.
COVID-19 and Flu Vaccination Requirement: It is required to be vaccinated for COVID-19 and Influenza. Exemption requests based on medical or religious reasons may be submitted, but must be approved for active employment.
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Performs utilization management continued stay reviews using established criteria to confirm medical necessity, appropriate level of care and efficient use of resources.
Serves as a resource to internal and external staff on issues related to utilization management
Education: Associates Degree or Diploma (RN) in Nursing. Bachelor’s Degree or higher preferred in nursing, business or related field, preferred.
Experience: 5+ years of nursing experience. Experience in Utilization Management, case management, denials or managed care highly preferred. Management experience a plus
License(s)/Certification(s): Registered Nurse – Licensed and registered in the states of Iowa and Illinois